Occult hepatitis B virus infection in hepatitis C virus negative chronic liver diseases

Abstract

Data concerning the prevalence of hepatitis B virus (HBV) occult infection (OBI) varies greatly in the different studies according to the sensitivity and specificity of the diagnostic approaches and the HBV prevalence in the different populations examined. The clinical implications of OBI are still debated. While the impact of OBI in HBV transmission as well as in HBV reactivation under immunosuppression are well established, the role of OBI in liver disease and hepatocellular carcinoma (HCC) development are still not definitively elucidated. It has been hypothesized that OBI might contribute to worsening the liver disease course when other causes of liver damage co‐exist. Furthermore, much evidence suggests a role of OBI in the hepato‐carcinogenesis processes through both indirect and direct oncogenic mechanisms that might favour HCC development. Data on the OBI clinical implications mainly come from studies performed in patients with hepatitis C virus (HCV) infection. However, HCV prevalence has dramatically fallen in the past years also because of the advent of specific and highly effective direct acting antivirals, with a consequent abrupt change of the worldwide scenario of chronic liver disease. Information about OBI prevalence and possible clinical impact in non‐HCV‐related liver disease are fragmentary, and the objective of this review is to critically summarize the available data in this field.

Occult Hepatitis B Virus Infection: An Update

“…Interestingly, some studies have shown an association between transaminase elevation and the reappearance of serum HBV DNA in chronic hepatitis C patients, suggesting a possible impact of such transitory HBV reactivation on hepatocyte necrosis [6,7]. A similar, negative impact of OBI on the progression of CLD has been shown in patients with alcoholic or cryptogenic liver disease and-recently-also in patients with NAFLD [72,88,89,130,131]. In particular, one study assessed the presence of HBV viral genomes in liver tissues collected from HBsAg-negative morbidly obese patients at the time of bariatric surgery, revealing a prevalence of about 13% of OBI, which was an independent predictor of NASH and fibrosis in these subjects [89].…”

“…A major and still widely debated topic is whether OBI may contribute to liver damage favoring the progression towards cirrhosis and the development of HCC in patients with CLD caused by different etiologic factors, such as HCV, non-alcoholic fatty liver, and alcohol-use disorders [ 122 , 123 , 124 , 125 , 126 , 127 , 128 , 129 , 130 , 131 , 132 , 133 ] ( Table 1 ). Indeed, patients who recover from a self-limited HBV acute hepatitis may persistently carry HBV genomes for several decades without showing any clinical or biochemical sign of liver injury [ 122 ], but when their liver tissues are examined, the histological signs of mild hepatic inflammation are revealed [ 123 , 124 ].…”

Insight on the hepatitis B virus and host immune mechanisms in the context of occult hepatitis

“…68 Coinfection with other microbes  Coinfection with HCV HBV and HCV coinfection reduces HBV replication and HBsAg expression in the liver. 15 HCV coinfection was connected to much greater spontaneous HBsAg clearance rates than HBV infection alone, showing that the two viruses/viral proteins interact. 69 Another research, on the other hand, showed no substantial interactions between the two viruses in coinfected hepatocytes, showing that host responses play a crucial role in viral dominance in coinfected cells.…”

“…Despite the possibility that OBI has a substantial role in the development or progression of chronic liver disease. 15 More research on the efficacy of OBI in chronic liver disease patients is needed because HBV DNA detection requires a liver biopsy, which is not regularly performed in clinical settings on most of these patients. 16 In addition, since most prior studies either had small sample sizes, heterogeneous populations, or were cross-sectional in nature, using multiple methodologies with varying sensitivity for HBV DNA determination in the liver or serum may clarify inconsistencies in the impact of OBI in patients with chronic liver disease.…”

The Clinical and Morphological Lesions of the Oral Mucosa And Periodontium With Viral Hepatitis C

“…7 A significant place in foreign literature is given to the study of the manifestation of chronic diffuse liver diseases in the oral cavity. 8 Studies of the oral cavity in chronic diffuse liver diseases are of great interest to clinicians since pathological processes developing in the liver, as a rule, 9,10,11 lead to organic and functional disorders in the oral mucosa. 12,13 In chronic diffuse liver diseases, changes are also observed in the periodontium.…”